Reminders can help seniors get their flu shot, but not all methods work, according to a Cochrane review.

Action Points

Explain to interested patients that reaching out directly to older adults reminding them to get their influenza vaccine appeared effective at raising immunization rates according to a meta-analysis.

Note that simply reminding physicians to remind patients to get a flu shot didn't do anything.

Reminders can help seniors get their flu shot, but not all methods work, according to a Cochrane review.

Personalized phone calls or postcards prompting older adults to get vaccinated appeared effective at raising immunization rates in all three quality trials that have been done, Roger E. Thomas, MD, PhD, of the University of Calgary, Alberta, and colleagues found.

House calls to improve access to flu shots and use of facilitators at the doctor's office appeared to help as well, although the evidence wasn't as good, Thomas' group reported in the Cochrane Library.

The evidence, though, for most interventions that have been tried is poor, mirroring the relatively scant evidence to support seasonal flu shots overall despite national recommendations that older adults and other higher-risk groups get vaccinated annually, the researchers cautioned.

The meta-analysis included 44 randomized controlled trials of interventions to increase influenza vaccination rates among adults 60 and older.

All were done in high-income countries -- primarily the U.S. -- among community-living individuals, and all assessed influenza vaccination status either through clinic records, billing data, or local or national vaccination registries.

Like evidence on flu shot efficacy, the evidence for interventions to boost immunization rates was relatively poor.

None of the trials were judged high quality. Only 12 got a nod for moderate quality.

Because of the heterogeneity even in studies with relatively similar interventions, the reviewers said they could not pool the data.

Of the 13 trials that used a letter, postcard, or phone call personalized to patient health status (total 40,301 patients in the intervention groups and 166,927 in the control groups), nine showed a significant benefit from the intervention. All three at low-to-moderate risk of bias suggested a positive effect on vaccination rates that was statistically significant.

Two of the four low-to-moderate bias trials that tested home visit interventions likewise showed a significant benefit, although one of the two was a small study.

When it came to interventions that tried to boost vaccination rates by reminding the physician, the Cochrane reviewers found no significant benefit in any of the three trials that had no more than moderate risk of bias. One even indicated a significant negative effect.

Using facilitators in the office to prompt flu vaccination among other preventive services did appear to significantly boost the number of seniors who got their flu shot in two of the three trials with low-to-moderate risk of bias.

Other trials tried group visits for vaccination, educating physicians or giving them financial incentives, and offering free flu shots. But because of the high risk of bias, no recommendations for practice could be drawn, Thomas' group concluded.

"The fact that the quality of evidence of most interventions is graded as at high risk of bias does not mean that the interventions might not work if properly evaluated, but simply that we do not have evidence at low risk of bias that they do," they cautioned in the paper.

They also noted that none of the trials occurred during the avian flu scare or 2009 H1N1 pandemic, which increased the level of concern among both providers and patients.

Still, low rates of vaccination against H1N1 were reported by the CDC in 2009 despite high levels of publicity. Whether interventions like the ones included in the meta-analysis could help in a pandemic situation is an open question, Thomas and colleagues indicated.

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